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This electronic material contained within this website and app (herein by, "the platform") is intended to provide you with detailed information about the policies, programs, agreements and consents of HerpAlert. Please read each section thoroughly before making your final decision to move forward with the potential diagnosis and treatment process.
I,, understand that HerpAlert is a telehealth marketing platform that connects patients and physicians. Diagnosis and treatments provided via the HerpAlert website and/or app is authorized and conducted by an outside healthcare professional contracted to utilize HerpAlert professional services.
I,, understand, agree and certify that the consents, agreements and policies contained on the platform shall be considered equivalent to traditional paper copies and I certify that my electronic signatures, electronic initials, auto-filled name and check boxes shall serve the legal equivalent of a physical, signed document. Moreover, I certify that the medical information I provide will be accurate and complete. I also understand and agree that this general consent will remain in effect for any and all treatments I choose, and may be supplemented in the future by written, electronic or verbal information from HerpAlert in the future.
I, , understand that a contracting HerpAlert healthcare professional may utilize a comprehensive team of healthcare professionals to assist, assess, implement and supervise patient diagnosis and treatment. These individuals may include physicians (MDs/DOs), Nurse Practitioners (NPs), Physician Assistants (PAs), Registered Nurses (RNs) and ancillary non-medical, administrative staff. I acknowledge that I may be treated by any of, any combination of, or even all of these allied health care professionals during the course of my potential diagnosis and treatment.
I, , understand and agree that diagnosis and treatment offered by HerpAlert are not covered by public or private insurance plans. I understand that HerpAlert will not submit any claims to any insurance carriers. I understand that payment is due before services are rendered. I fully acknowledge that I am personally responsible for all fees and charges incurred in connection with my purchase, and I completely understand that there is absolutely NO refunding of any patient fees, payments, charges, credit, gift certificates, product purchases, pre-paid packages or services. HerpAlert prides itself on patient satisfaction but I understand and agree that HerpAlert also retains the right to refuse service to anyone.
I, , understand, agree and consent that HerpAlert and their employees, independent contractors, associates, agents and representatives participate in Telehealth (telemedicine), and will require that photographs and/or use video (for "store & forward" or teleconferencing technology) of the area to be diagnosed and treated. These recordings will be available only to our medical staff members. HerpAlert follows HIPAA guidelines regarding patient confidentiality and privacy, therefore recordings are used internally. Only the treated area/area to be assessed will be shown in these photographs and videos.
I, , understand and agree that HerpAlert will contact me. I will allow this communication to come in the form of live telephone calls, automated telephone appointment reminder calls, text messages, e-mails, electronic surveys, App notifications, U.S mail, social media or by any means convenient to HerpAlert. I understand that HerpAlert may also send other communications informing me of changes to office policies, new technology, announcements and specials that I may find invaluable or informative. I understand that I may opt out of any or all communication measures any time by contacting HerpAlert in writing.
I, , understand that I have a right to view a copy of my medical records. In accordance with state regulations, I understand that there may be a "reasonable fee" associated with copying medical records. At HerpAlert this fee typically consists of an administrative charge of $10.00 plus $0.25 for each black & white page, and $1.00 per color page and photograph. This fee may be altered or amended depending on the specific state in which you are located. I understand that this administrative fee must be received prior to the printing and mailing of the records. All documents will be printed and then physically mailed to an address that you provid. I understand that medical records (including photos) will not be transmitted via e-mail or fax.
I, , agree and certify that I have had ample time to read this electronic agreement in its entirety, and that I have thoroughly reviewed each and every section that I have signed and/or initialed electronically. I also certify that I have not taken any medication that might impair my ability to understand this information, and was not rushed or pressured to agree and/or certify to the information contained herein.
I, , understand that many states have laws regarding the exposure and/or transmission of an STD (sexually transmitted disease). I acknowledge that HerpAlert cannot offer information or advice to me in this regard and I agree to seek a legal opinion from an attorney in my state on this matter if necessary. Furthermore, I agree that the disclosure of my sexual health history to past, present, and future partners is my own responsibility. I understand that HSV (herpes simplex virus) cannot be cured and having HSV any necessitate continued treatment over time.
I,, understand and agree that if my suspected herpes lesions persist or worsen, or if any other medical condition or symptom arises, I will promptly follow up with a healthcare provider in-person. I certify that my health care is my sole responsibility and HerpAlert only provides temporary treatment for the symptoms herpes simplex virus.
I, , understand that a cure for herpes or cold sores is not possible. I do understand that the frequency and duration of a herpes or cold sore outbreak can be minimized with prompt treatment via an oral anti-viral medication and that is the reason I am seeking care from HerpAlert.
I, , understand that HerpAlert offers a traditional diagnosis of herpes and cold sores via an electronic review of a patient's history, current symptom(s), and/or electronic clinical pictures. I do understand that alternatives to diagnosis exist and include, but are not limited to, a microscopic evaluation of an active herpes sore or a PCR blood test. As such, by utilizing HerpAlert, I am agreeing to be diagnosed via the traditional method of clinical information evaluation. I understand and agree that if I am interested in diagnosis via another means, I will make arrangements to be evaluated in-person by a healthcare provider in my area.
I, , understand that HerpAlert may provide a prescription anti-viral medication to me. This medication is provided at the sole discretion of the prescribing doctor. While I may request a specific medication, dose, or amount, I fully understand that the healthcare practitioner has no obligation to fulfill my request. Because the treatment of herpes and cold sores is completely voluntary and elective, an alternative option is no treatment at all.
I, , understand that HerpAlert may not provide me with a refill of the anti-viral medication I have been prescribed. I understand that I will have to reuse the HerpAlert platform, pay another fee, and request a new medication when the need arises.
I, , understand that the having one sexually transmitted infection (like herpes or cold sores) statistically increases the likelihood of having a different sexually transmitted infection. I agree that it is my sole responsibility to seek diagnosis and treatment of all other sexually transmitted infections and diseases as well as for the care of my overall health.
I, , understand that any prescription medication can have side effects. I certify that I will discuss all potential side effects with the pharmacy staff when I pick up the medication I am prescribed.
I, , agree to start or maintain a relationship with a primary care provider as HerpAlert only diagnoses and treats the herpes simplex virus.
I, , have been given ample time to read this informed consent and I agree to it completely and fully.
Date Of Birth:
Date Of Consent:
All capitalized terms used in this Informed Consent for Telemedicine Services (“Consent Form”) but not defined herein have the meanings assigned to them in the Terms of Service available on www.HerpAlert.com (“Website”). For avoidance of any doubt, the terms "HerpAlert", "we", "us", or "our" refer to Derma Corporation and HA Telehealth, P.C. doing business as HerpAlert, and the terms “I” "you" and "yours" refer to the client using the Service and Website and App (collectively, the “Platform”).
The purpose of this Consent Form is to provide you with information about telemedicine and to obtain your informed consent to participate in a telemedicine health service as part of your medical care.
Telemedicine involves the delivery of healthcare services using electronic communications, information technology or other means between a healthcare professional and a client who are not in the same physical location. Telemedicine may be used for diagnosis, treatment, follow-up and/or client education, and may include, but is not limited to:
Use of Telemedicine:
As with any medical service, there are potential risks associated with the use of telemedicine. The potential risks associated with the use of telemedicine are rare, but may include the following:
The Providers at HerpAlert may be providing you with prescription medications. As with any medications, those prescribe to you may result in adverse reactions. Please note that if you are taking any additional medications there may be the potential for drug interactions between your existing medications and the medications prescribed. By signing this informed consent form you are agreeing to provide an accurate list of all prescription and over the counter medications you are currently taking or have taken within the past month. While our medical Providers prescribing you these medications will check for potential medications interactions before prescribing medication, our Providers are not liable for any harm or damages caused by an adverse reaction caused by these medications directly or any associated medication interactions.
The medication, if approved, may not be shipped in child-resistant packaging and must be kept out of the reach of children. Given regulatory requirements in certain jurisdictions, your professional(s) treatment options, especially pertaining to certain prescriptions may be limited.
YOU AGREE TO INDEMNIFY AND HOLD HARMLESS DERMA CORPORATION AND HA TELEHEALTH P.C., ITS EMPLOYEES, AGENTS, DIRECTORS, CLIENTS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS FROM AND AGAINST ANY AND ALL LOSS, DAMAGE, EXPENSE, LIABILITY, CLAIM, OR DEMAND WHATSOEVER, ARISING OUT OF OR RELATED TO ANY FAILURE OF TECHNOLOGY OR EQUIPMENT IN CONNECTION WITH THE PROVISION OF TELEMEDICINE WHETHER OR NOT ANY SUCH LOSS, DAMAGE, EXPENSE, LIABILITY, CLAIM, OR DEMAND ARISES FROM OR RELATES TO THE NEGLIGENCE OF DERMA CORPORATION AND HA TELEHEALTH P.C.
HerpAlert uses network and software security protocols to protect the confidentiality of your patient health information, including for example your medical record, EMR, imaging, and personal financial data. These protocols are designed to safeguard the data and to ensure its integrity against corruption. Use of the Platform and Services is governed by our Notice of Privacy Practices, copies of which may be found on our Website. If you choose to share your protected health information over email, telephone or video communications, you acknowledge that such email, telephone or video communications may not be encrypted and/or may not be a secure method of communication, and you assume the risk of such unsecured communications. You authorize HerpAlert to use and publish any comments you choose to share about the Service, including comments shared in patient satisfaction surveys, unless otherwise specified. HerpAlert will only publish comments using your first name.
By accepting this Informed Consent for Telemedicine Services, you acknowledge and agree to the following:
TERMS OF SERVICE
Welcome to www.HerpAlert.com (the "Website") which is operated by Derma Corporation and used by HA Telehealth, P.C. doing business as HerpAlert ("HerpAlert"). Your use of the Website, the related HerpAlert App (the "App") and any medical advice or services delivered by third-party medical professionals through the Website or App (the "Services") are subject to these Terms of Service, our Notice of Privacy Practices and any other terms or conditions of use stated on the Website or in the App. By using the Website and/or App (collectively, the "Platform"), you accept these Terms of Service and other conditions of use in full and without reservation. If you disagree with the Terms of Service in all or in part, you should not use the Website, the App or Services.
The Platform is a service for clients like you to manage their health using email, telephone and telecommunications-enabled care from physicians and other health care professionals contracted and affiliated with HerpAlert ("Providers").
DO NOT USE THE HERPALERT PLATFORM FOR EMERGENCY MEDICAL NEEDS. IF AT ANY TIME YOU EXPERIENCE A MEDICAL EMERGENCY, IMMEDIATELY CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM.
These Terms of Service Are a Contract
These Terms of Service and other conditions of use constitute a contract with legally binding terms of your use of the Platform and Services. You should carefully read these Terms of Service which is sometimes referred to below as the "Agreement."
This Agreement may be modified by HerpAlert from time to time, and such modifications will be effective upon posting by HerpAlert on the Platform. This Agreement incorporates by reference HerpAlert’s Notice of Privacy Practices and any notices regarding the Platform or policies posted on the Platform. By accessing the Platform, you accept this Agreement and agree to the terms, conditions and notices contained or referenced herein.
If helpful, you may request a non-electronic copy of this Agreement at any time, simply email info@HerpAlert.com and we will provide a copy of this Agreement as soon as possible. Likewise, you have the right at any time to withdraw your consent to this Agreement by sending an email to the address provided above.
You must be at least 18 (eighteen) years of age to use the Platform or Services. By using the Platform and by agreeing to the Terms of Service, you warrant and represent that you are at least 18 years of age.
You are responsible for paying for the Services you receive. HerpAlert will not seek payment or reimbursement on your behalf from any third-party payor, including any commercial insurer, managed care organization, preferred provider organization, Medicare, Medicaid, or any other health care program.
HerpAlert may bill you for the Services rendered using the credit card information you provide while using the Platform. You agree to pay HerpAlert all charges at the prices then in effect for any use of the Services using your credit card information, and you authorize HerpAlert to charge your chosen payment provider for the Services. HerpAlert reserves the right to correct any errors or mistakes that it makes even if it has already requested or received payment.
Modifications to Services Offered
HerpAlert reserves the right at any time to alter, modify, update, or discontinue, temporarily or permanently, the Services at any time with or without notice. HerpAlert may conduct such modifications to our Services for security reasons, intellectual property, legal reasons, or various other reasons at our discretion, and HerpAlert is not required to provide notice or explanation of such modifications. HerpAlert shall not be liable to you or to any third party for any modification, suspension or discontinuance of the Services.
Protection of Your Account
You are responsible for maintaining the confidentiality of the username and password that you designate during the registration process, and you are fully responsible for all activities that occur under your username and password. We ask that you immediately notify HerpAlert if you become aware of any unauthorized use of your username or password or any other breach of security related to your account, and ensure that you exit and logout from your account at the end of each session. We are not liable for any loss or damage arising from your failure to comply with this provision.
Use of the Website, App and Services is governed by our Notice of Privacy Practices, copies of which may be found on our Website. If you choose to share your protected health information over email, telephone or video communications, you acknowledge that such email, telephone or video communications may not be encrypted and/or may not be a secure method of communication, and you assume the risk of such unsecured communications. You authorize HerpAlert to use and publish any comments you choose to share about the Service, including comments shared in patient satisfaction surveys, unless otherwise specified. HerpAlert will only publish comments using your first name.
Providers as Independent Contractors
Providers listed on HerpAlert’s Website are licensed medical professionals and independent contractors. Such Providers are not employees of either HerpAlert or Derma Corporation. You are solely responsible for your interactions with Providers and you release both HerpAlert and Derma Corporation from any and all claims or liabilities related to any product or services of Providers and any action or inaction by Providers, including Providers’ failure to comply with applicable law and/or conduct or speech, whether online or offline.
Any opinions, advice, or information expressed by any Provider are those of the individual Provider and they do not reflect the opinions of HerpAlert or Derma Corporation. Lastly, neither HerpAlert nor Derma Corporation is liable for any indirect or direct physical, psychological, emotional, financial damages of any kind arising from any opinions or content rendered by Providers.
Lifestyle and Wellness Services
The lifestyle and wellness offerings made available through the HerpAlert platform are provided by Alexandra Harbushka. Alexandra is an independent third party and not an employee of HerpAlert or any of the physicians who provide services through HerbAlert. The services offered by Alexandra Harbushka are intended to educate, inform and inspire you to reach your optimal health and a thriving life. They are non-medical in nature and do not constitute health care, medical or nutritional therapy services. Please ask your physician or another licensed health care professional about the diagnosis, prevention, or treatment of herpes or any other disease, condition or physical or mental ailment of the human body.
Providers may be able to send you text messages via App notifications to provide comments or updates regarding your Services. You can manage such push notifications in your mobile device’s settings ("Provider Content"). Under no circumstances will HerpAlert or Derma Corporation be liable for any loss or damage caused by any Provider Content or your reliance on such content. It is your responsibility to evaluate the accuracy, completeness, or usefulness of any information, opinion, or advice, including any Provider Content available through the HerpAlert Platform or Service. If you have any questions regarding Provider Content please contact your primary care physician or healthcare provider.
Permission to Treat
By completing registration through the Platform, you give permission for Providers to provide you with the Services. You may withdraw this consent at any time by no longer seeking Services through the Platform or by providing notice to HerpAlert of such withdrawal. HerpAlert has the right to refuse access to its Platform or its Services to any person at any time, for any reason, or for no reason at all.
Copyright and Trademark
Derma Corporation owns and retains all proprietary rights in the Platform. The Platform contains the copyrighted material, trademarks, and other proprietary information. Except for that information which is in the public domain or for which you have been given written permission, you may not copy, modify, publish, transmit, distribute, perform, display, or sell any such proprietary information.
The design of the Platform, created text, writings, images, templates, scripts, graphics, interactive features and the trademarks and service marks ("Mark or Marks"), and logos contained therein, are owned by or licensed to HerpAlert, subject to copyright and other intellectual property rights under United States and foreign laws and informational conventions.
You may not post, distribute, or reproduce in any way any copyrighted material, trademarks, or other proprietary information without obtaining the prior written consent of the owner of such proprietary rights.
You are not authorized to use any Mark in any advertisement, publicity or in any other commercial manner without our prior written consent. The trade names, trademarks, service marks, logos and slogans used in the Platform that are not our Marks are the trade names, trademarks, service marks, logos and slogans of their respective owners.
Services: You agree that your use of the Services is at your own risk. The Platform and Services are not intended for use in a medical emergency or in case of an urgent healthcare need, and you agree that you will seek care elsewhere in the event of a medical emergency or urgent healthcare need. Do not delay receiving treatment for any health or medical issues due to any information found on our website or service. Always use common sense when making health decisions.
HerpAlert is not responsible for any incorrect or inaccurate content posted on the Website, App or in connection with the Service, whether caused by users of the Platform or programming associated with or utilized in the Services.
HerpAlert is not responsible for any problems or technical malfunction of any telephone network or lines, computer online systems, servers or providers, computer equipment, software, or failure of email on account of technical problems or traffic congestion on the Internet or at any Platform or combination thereof. Under no circumstances will HerpAlert or any of its affiliates, advertisers, promoters or distribution partners be responsible for any loss or damage, including personal injury or death, resulting from anyone’s use of the Platform or the Services, any content posted on the Platform or transmitted to users, or any interactions between users of the Platform, whether online or offline.
The Platform and the Services are provided "AS-IS" and HerpAlert expressly disclaims any warranty of fitness for a particular purpose or non-infringement. HerpAlert cannot guarantee and does not promise any specific results from use of the Platform and/or the Services.
By agreeing to the Terms of Service, you also agree that you are required to resolve any claim or dispute that you may have against HerpAlert or Derma Corporation on an individual basis in arbitration, as set forth in this Arbitration Agreement. This will preclude you from being in any class, collective, or representative action against HerpAlert or Derma Corporation, and also precludes you from participating in or recovering relief under any current or future class, collective, consolidated, or representative action brought against HerpAlert or Derma Corporation by someone else.
Agreement to Binding Arbitration Between You and HerpAlert and/or Derma Corporation: You, HerpAlert and Derma Corporation agree that any dispute, claim or controversy arising out of or relating to (a) these Terms of Service or the existence, breach, termination, enforcement, interpretation, medical malpractice, security breaches, or violations of HIPAA or validity thereof, or (b) your access to or use of the Platform or Services at any time, whether before or after the date you agreed to the terms, and in any state from which you access the Platform will be settled by binding arbitration between you and HerpAlert or Derma Corporation, and not in a court of law.
You acknowledge and agree that you, HerpAlert and Derma Corporation are each waiving the right to a trial by jury or to participate as a plaintiff or class member in any purported class action or representative proceeding. Unless you, HerpAlert and Derma Corporation otherwise agree in writing, any arbitration will be conducted only on an individual basis and not in a class, collective, consolidated, or representative proceeding. However, you, HerpAlert and Derma Corporation each retain the right to bring an individual action in small claims court and the right to seek injunctive or other equitable relief in a court of competent jurisdiction to prevent the actual or threatened infringement, misappropriation or violation of a party's copyrights, trademarks, trade secrets, patents or other intellectual property rights.
Rules and Governing Law: The arbitration will be administered by the American Arbitration Association ("AAA") in accordance with the AAA’s Consumer Arbitration Rules and the Supplementary Procedures for Consumer Related Disputes (the "AAA Rules") then in effect, except as modified by this Arbitration Agreement. The AAA Rules are available at www.adr.org/arb_med or by calling the AAA at 1-800-778-7879.
The parties agree that the arbitrator ("Arbitrator"), and not any federal, state, or local court or agency, shall have exclusive authority to resolve any disputes relating to the interpretation, applicability, enforceability or formation of this Arbitration Agreement, including any claim that all or any part of this Arbitration Agreement is void or voidable. The Arbitrator shall also be responsible for determining all threshold arbitrability issues, including issues relating to whether the Terms of Service are unconscionable or illusory and any defense to arbitration, including waiver, delay, laches, or estoppel.
Notwithstanding any choice of law or other provision in the Terms of Service, the parties agree and acknowledge that this Arbitration Agreement evidences a transaction involving interstate commerce and that the Federal Arbitration Act, 9 U.S.C. § 1 et seq. ("FAA"), will govern its interpretation and enforcement and proceedings pursuant thereto. It is the intent of the parties that the FAA and AAA Rules shall preempt all state laws to the fullest extent permitted by law. If the FAA and AAA Rules are found to not apply to any issue that arises under this Arbitration Agreement or the enforcement thereof, then that issue shall be resolved under the laws of the state of California.
This Arbitration Agreement is also binding pursuant to the Medical Arbitration Rules of the California Medical Association, as they may be amended from time to time, which Rules are hereby incorporated into this Agreement.
NOTICE: BY SIGNING THIS CONTRACT YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A JURY OR COURT TRIAL.
Waiver of Class Actions
You also agree to waive your ability to participate in a class action lawsuit or proceeding related to any use or information provided by HerpAlert, Derma Corporation and/or your use of the Platform or Service. You have no authority for any claims to be arbitrated on a class or representative basis and an arbitrator may not consolidate or join claims of other persons or parties who may be similarly situated.
Links: The Platform may provide links to websites operated by third parties. These links are provided solely for convenience and reference purposes only. The inclusion of any such link does not imply that we endorse the content of any web site to which the Platform provides a link, nor are we liable for your reliance on or use of any information or materials contained in them.
User Feedback: You may be asked to provide feedback on your HerpAlert experience and providing your feedback is optional. This feedback may be hosted and stored at a third party site. You agree to not provide any personally identifiable information when providing feedback.
Limitation on Liability: To the extent permitted by law, in no event will HerpAlert or Derma Corporation be liable to you or any third person for any indirect, consequential, exemplary, incidental, special or punitive damages arising from your use of the Platform or the Services, including any acts or omissions of Providers. HerpAlert’s and Derma Corporation’s liability to you for any cause whatsoever, and regardless of the form of the action, will at all times be limited to the amount paid, if any, by you to HerpAlert for the Services.
Indemnification: You agree to indemnify and hold HerpAlert and Derma Corporation, its subsidiaries, affiliates, officers, agents, and other partners and employees, harmless from (a) any loss, liability, claim, or demand, including reasonable attorney’s fees, made by any third party due to or arising out of your use of the Platform or Services in violation of this Agreement, (b) your failure to comply with applicable laws and regulations; and/or (c) your breach of this Agreement and/or any breach of your representations and warranties set forth above.
Jurisdiction and Choice of Law. If there is any dispute arising out of the Platform and/or the Service, by using the Website or App, you expressly agree that any such dispute shall be governed by the laws of the State of California, without regard to its conflict of law provisions.
No Third Party Beneficiaries. You agree that, except as otherwise expressly provided in this Agreement, there shall be no third party beneficiaries to this Agreement. The terms of this Agreement shall bind you, your heirs and any representatives and HerpAlert and Derma Corporation and their respective assignees and successors.
Assignment of Rights and Obligations. You agree not to assign any of your rights and/or obligations under this Agreement to any other party without HerpAlert’s or Derma Corporation’s prior written consent. However, HerpAlert or Derma Corporation may assign our rights and/or obligations under this Agreement to any other person at our discretion.
Acknowledgment of Terms
You agree that you may be sent electronic notices to the email address provided during your registration for the Services. Any notice sent to that email address will be effective once delivered, regardless of whether or not you actually received the notice or choose to read it.
I have read this agreement and agree to all of the provisions contained above.
I hereby certify that I am at least 18 years of age and possess the legal right and ability to enter into this Agreement under the name in which I have registered to use the Services. I understand and acknowledge that my ability to access and use the Platform and the Services is conditional upon the abovementioned criteria of my certification of age and legal authority at the time that I access the Services, and that the Providers rely upon this certification in order to interact and facilitate health care services with me.
If you have any questions about the Terms of Service or otherwise need to contact HerpAlert for any reason, you can reach us at Support Team at Support@HerpAlert.com
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